The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action

Healthy life expectancy for 202 countries up to 2030: Projections with a Bayesian model ensemble

Background

Healthy life expectancy (HLE) projections are required for optimising social and health service management in the future. Existing studies on the topic were usually conducted by selecting a single model for analysis. We thus aimed to use an ensembled model to project the future HLE for 202 countries/region.

Methods

We obtained data on age-sex-specific HLE and the sociodemographic index (SDI) level of 202 countries from 1990 to 2019 from the Global Burden of Disease (GBD) database and used a probabilistic Bayesian model comprised of 21 forecasting models to predict their HLE in 2030.

Results

In general, HLE is projected to increase in all 202 countries, with the least probability of 82.4% for women and 81.0% for men. Most of the countries with the lowest projected HLE would be located in Africa. Women in Singapore have the highest projected HLE in 2030, with a 94.5% probability of higher than 75.2 years, which is the highest HLE in 2019 across countries. Maldives, Kuwait, and China are projected to have a probability of 49.3%, 41.2% and 31.6% to be the new entries of the top ten countries with the highest HLE for females compared with 2019. Men in Singapore are projected to have the highest HLE at birth in 2030, with a 93.4% probability of higher than 75.2 years. Peru and Maldives have a probability of 48.7% and 35.3% being new top ten countries in male's HLE. The female advantage in HLE will shrink by 2030 in 117 countries, especially in most of the high SDI and European countries.

Conclusions

HLE will likely continue to increase in most countries and regions worldwide in the future. More attention needs to be paid to combatting obesity, chronic diseases, and specific infectious diseases, especially in African and some Pacific Island countries. Although gender gaps may not be fully bridged, HLE could partially mitigate and even eliminate them through economic development and improvements in health care.

Adipose Tissue-Derived Extracellular Vesicles: A Promising Biomarker and Therapeutic Strategy for Metabolic Disorders

Adipose tissue plays an important role in systemic energy metabolism, and its dysfunction can lead to severe metabolic disorders. Various cells in adipose tissue communicate with each other to maintain metabolic homeostasis. Extracellular vesicles (EVs) are recognized as novel medium for remote intercellular communication by transferring various bioactive molecules from parental cells to distant target cells. Increasing evidence suggests that the endocrine functions of adipose tissue and even the metabolic homeostasis are largely affected by different cell-derived EVs, such as insulin signaling, lipolysis, and metabolically triggered inflammation regulations. Here, we provide an overview focused on the role of EVs released by different cell types of adipose tissue in metabolic diseases and their possible molecular mechanisms and highlight the potential applications of EVs as biomarkers and therapeutic targets. Moreover, the current EVs-based therapeutic strategies have also been discussed. This trial is registered with NCT05475418.

Trends in overweight and obesity in children under 24 months of age in Mexico (2012-2020): analysis of four national health surveys

The prevalence of childhood obesity has increased rapidly in Mexico, with significant consequences for the population's health in the future. Little is known about the prevalence of obesity in children under two years of age, even though this life stage is fundamental to prevent this condition. This study aims to determine the magnitude, distribution, and trends of overweight and obesity in children under 24 months of age using the Mexican National Health and Nutrition Surveys (ENSANUT) conducted in the last 10 years. The data presented here are derived from four ENSANUTs, carried out in Mexico in 2012, 2016, 2018, and 2020. They include 6,719 infants under 24 months with complete anthropometric data (weight/height) by age, gender, Indigeneity, area of residence, and socioeconomic status. The risk of overweight levels and overweight + obesity rates were calculated according to World Health Organization guidelines. We identified that infants < 12 months currently have a higher prevalence of overweight + obesity (10.3%) and that those aged 12 to 23 months are generally at a higher risk of overweight (26.1%). The most relevant findings of this study, linking weight trends to sex, region, socioeconomic status, and indigeneity, show that overweight and obesity prevalences vary across the Mexican population, without presenting a specific behavior. There is a high prevalence of overweight and obesity among Mexican infants and a slight trend toward increased obesity in infants < 12 months. Weight monitoring and obesity prevention interventions focused on the first 1,000 days of life are essential.

Effects of accelerometer-based sedentary time and physical activity on DEXA-measured fat mass in 6059 children

Globally, childhood obesity is on the rise and the effect of objectively measured movement behaviour on body composition remains unclear. Longitudinal and causal mediation relationships of accelerometer-based sedentary time (ST), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) with dual-energy X-ray absorptiometry-measured fat mass were examined in 6059 children aged 11 years followed-up until age 24 years from the Avon Longitudinal Study of Parents and Children (ALSPAC), UK birth cohort. Over 13-year follow-up, each minute/day of ST was associated with 1.3 g increase in fat mass. However, each minute/day of LPA was associated with 3.6 g decrease in fat mass and each minute/day of MVPA was associated with 1.3 g decrease in fat mass. Persistently accruing ≥60 min/day of MVPA was associated with 2.8 g decrease in fat mass per each minute/day of MVPA, partly mediated by decrease insulin and low-density lipoprotein cholesterol. LPA elicited similar and potentially stronger fat mass-lowering effect than MVPA and thus may be targeted in obesity and ST prevention in children and adolescents, who are unable or unwilling to exercise.

Beyond the Metabolic Syndrome: Non-Obvious Complications of Obesity in Children

Obesity is currently one of the most significant public health challenges worldwide due to the continuous increase in obesity rates among children, especially younger children. Complications related to obesity, including serious ones, are increasingly being diagnosed in younger children. A search was performed from January 2023 to September 2023 using the PubMed, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases. The focus was on English-language meta-analyses, systematic reviews, randomized clinical trials, and observational studies worldwide. Four main topics were defined as follows: disorders of glucose metabolism; liver disease associated with childhood obesity; the relationship between respiratory disorders and obesity in children; and the effects of obesity on the hypothalamic-pituitary-gonadal axis and puberty. Understanding potential complications and their underlying mechanisms can expedite the diagnostic process and enhance the effectiveness of treatment. We aspire that this study will bring insight into the often-overlooked complications associated with obesity.

Aerobic Exercise Training Under Normobaric Hypoxic Conditions to Improve Glucose and Lipid Metabolism in Overweight and Obese Individuals: A Systematic Review and Meta-Analysis

Guo, Hai, Linjie Cheng, Dilihumaier Duolikun, and Qiaoling Yao. Aerobic exercise training under normobaric hypoxic conditions to improve glucose and lipid metabolism in overweight and obese individuals: a systematic review and meta-analysis. High Alt Med Biol. 24:312-320, 2023. Background: Obesity is a critical public health issue around the world, reaching epidemic proportions in some countries. However, only a few studies have examined the effects of hypoxic training on metabolic parameters in an obese population. This systematic review and meta-analysis aimed to determine the effects of aerobic exercise training under normobaric hypoxic conditions versus normoxic training in improving glucose and lipid metabolism in obese individuals. Methods: A systematic search of PubMed, EMBASE, Web of Science, and Wan Fang databases (up to August 2021) was performed to identify randomized controlled trials (RCTs) of overweight or obese human subjects eligible for inclusion. Main study endpoints were changes in body mass index (BMI), waist/hip (W/H) ratio, leptin, blood glucose and insulin levels, as well as blood lipids between hypoxic and normoxic conditioning. Results: Fourteen RCTs with a total of 413 subjects qualified for inclusion. Pooled analyses revealed that BMI (d = 0.38), W/H ratio (d = 0), blood glucose (d = 0.01), and triglyceride (d = -2.27) were not significantly different between aerobic exercise training under hypoxic and normoxic conditions. However, significant differences were found in heart rate at rest (d = -4.50) between aerobic exercise training under hypoxic versus normoxic conditions. Conclusions: In conclusion, no significant benefits were noted in aerobic exercise training under hypoxic conditions over normoxic conditions in overweight or obese individuals. However, the maximum training heart rate mm was significantly higher under hypoxic conditions than under normoxic conditions. Future studies with larger samples controlling for exercise-related parameters, and addressing the potential modifying effects of level of hypoxia, sex, or age on the role of hypoxic exercise training are warranted. PROSPERO registration number: CRD42020221680.

Childhood obesity, metabolic syndrome, and oxidative stress: microRNAs go on stage

The incidence of childhood obesity and metabolic syndrome has grown notably in the last years, becoming major public health burdens in developed countries. Nowadays, oxidative stress is well-recognized to be closely associated with the onset and progression of several obesity-related complications within the framework of a complex crosstalk involving other intertwined pathogenic events, such as inflammation, insulin disturbances, and dyslipidemia. Thus, understanding the molecular basis behind these oxidative dysregulations could provide new approaches for the diagnosis, prevention, and treatment of childhood obesity and associated disorders. In this respect, the transcriptomic characterization of miRNAs bares great potential because of their involvement in post-transcriptional modulation of genetic expression. Herein, we provide a comprehensive literature revision gathering state-of-the-art research into the association between childhood obesity, metabolic syndrome, and miRNAs. We put special emphasis on the potential role of miRNAs in modulating obesity-related pathogenic events, with particular focus on oxidative stress.

Effect of an educational intervention on diet and physical activity among school-aged adolescents in Delhi -The i-PROMISe (PROMoting health literacy in Schools) Plus Study

Purpose

Emerging lifestyle changes due to rapid urbanization have led to an epidemiological transition and the rising prevalence of obesity is responsible for major non-communicable diseases (NCDs) which have further aggravated due to the COVID-19 pandemic. This study aims to assess the effectiveness of a comprehensive school-based intervention on diet and physical activity-related behavior of adolescents.

Methods

In 2019, a cluster-randomized controlled trial was conducted in randomly selected (n = 8) private schools. A 2-year intervention program was implemented over consecutive academic years (2019-2020 and 2020-2021) with students who were in the 6th and 7th grades when the study began. Four schools were randomly assigned to the intervention (n = 794) and four schools to the control group (n = 774).

Results

The difference in changes in diet and physical-activity-related behaviors of the students between the intervention and control schools were not significant in the intention to treat analysis probably due to the large drop-out due to COVID-19 measures: 304 students were available for follow-up in the intervention group and 122 in the control group (391 cases were excluded to make data comparable with baseline survey). The intake of vegetables (once a day) [β = 0.35, OR = 1.42, 95% CI (1.03, 1.95)] in the per-protocol analysis has increased among adolescents in the intervention group as compared to the control group.

Conclusion

The findings of this study indicated a positive effect of the intervention on diet and physical-activity-related changes in the expected direction and highlights the importance of addressing such behavior to prevent obesity among adolescents and thus NCDs in the later stage of life.

Feeding Homemade Sugar Sweetened Beverages in Addition to Breastfeeding: Survey Results from Caregivers of Infants and Young Children in Peri-Urban Lima, Peru

OBJECTIVES

Consumption of sugar sweetened beverages (SSB) is associated with childhood obesity and other negative health conditions. Feeding SSB to infants and young children (IYC) under 2 years may displace consumption of breastmilk and nutrient rich foods critical for optimal growth and development. The World Health Organization (WHO) recommends avoiding added sugar (e.g. SSB) for IYC under 2 years. We sought to describe the variety of homemade and commercial SSB as well as breastmilk and beverages without added sugar fed to IYC aged 4-23 months living in a low-income, populous peri-urban area of Lima, Peru.

METHODS

A cross-sectional survey was conducted with 181 households with IYC aged 4-23 months. A list of common local homemade and commercial beverages was used to investigate what caregivers had fed to the child in the past 24 h.

RESULTS

A total of 93.9% of caregivers reported feeding at least one beverage to their child other than breastmilk in the past 24 h. This included a variety of homemade SSB (73.5%), commercial SSB (18.2%) and homemade beverages without added sugar (70.2%). A high percentage (83.4%) of children were also breastfed.

CONCLUSIONS FOR PRACTICE

Our findings suggest that interventions to address feeding homemade SSB to IYC within households are needed to support WHO recommendations and complement current commercial SSB policy regulations in Peru.

Trends of obesity and overweight among children and adolescents in China

BACKGROUND

Recent decades have shown a rapid increase in the prevalence of overweight and obesity among Chinese children based on several national surveys. Restrictions due to the coronavirus disease 2019 outbreak have worsened its epidemiology. This review updates the trends in the prevalence of overweight and obesity among Chinese children and adolescents and analyzes the underlying reasons to provide evidence for better policy making.

METHODS

Studies published in English and Chinese were retrieved from PubMed, Google Scholar, China National Knowledge Infrastructure and Wanfang.

RESULTS

The prevalence of overweight and obesity has been increasing for decades and varies with age, sex and geography but is more pronounced in primary school students. The increase in obesity in boys appeared to be slower, whereas that in girls showed a declining trend. The northern areas of China have persistently maintained the highest levels of obesity with a stable trend in recent years. Meanwhile, the prevalence in eastern regions has dramatically increased. Notably, the overall prevalence of obesity in children has shown a stabilizing trend in recent years. However, the occurrence of obesity-related metabolic diseases increased. The effect of migrants floating into east-coast cities should not be neglected.

CONCLUSIONS

The high prevalence of overweight and obesity among Chinese children and adolescents persists but with varying patterns. Obesity-related metabolic diseases occur more frequently despite a stable trend of obesity. Multiple factors are responsible for the changing prevalence. Thus, comprehensive and flexible policies are needed to effectively manage and prevent the burden of obesity and its related complications.

Addressing a Growing Crisis: Exploring Novel Insights and Solutions in Research on Nutrition and Childhood and Adolescent Obesity

Given the escalating global prevalence of non-communicable diseases (NCDs), it is consequently crucial to address childhood obesity by promoting lifestyle adjustments, as exemplified in the World Health Organization's Package of Essential Non-Communicable Disease Interventions for Primary Healthcare [...].

How do adolescents classify foods as healthy and unhealthy?: A qualitative inquiry from rural India

Indian adolescents exhibit obesogenic dietary habits including low intake of fruits and vegetables and increasing consumption of fast food and carbonated beverages. Adolescents' classification of healthy and unhealthy foods is likely to have significant implications for their dietary behaviour, and consequently, their health. However, there is limited evidence about the ways Indian adolescents classify foods as healthy or unhealthy. Hence, this qualitative study was designed to explore how Indian adolescents classify nutritious or non-nutritious food choices. Convenience sampling was used to recruit the study participants from Tikari village in Uttar Pradesh, India. Underpinned by the social constructivist lens, the adolescents were interviewed face-to-face in Hindi. All the interactions were digitally recorded, transcribed verbatim, and translated into English prior to data analysis. Transcribed data were analysed thematically using inductive as well as deductive coding, and subsequently, conceptual themes were extracted. A total of thirty-nine adolescents (twenty boys; nineteen girls) aged 10-19 years participated in this qualitative inquiry. The adolescents classified healthy and unhealthy foods based on the following six themes: (i) Food groups and nutrients; (ii) Health and immunity; (iii) Type of ingredient; (iv) Place and time of food preparation; (v) Packaging; and (vi) Parental influence. These findings can inform school-based food literacy interventions to foster healthy dietary habits and cooking skills among Indian adolescents.

The relationship between family function and the incidence of overweight/obesity in children and adolescents in Chengdu city, Sichuan province of China: based on latent profile analysis

BACKGROUND

Overweight/obesity in children and adolescents has become a global health problem, and family function may be associated with its occurrence. Studies exploring the association between family function and overweight/obesity in children and adolescents were performed in Western and Taiwan, China. To date, related studies haven't been conducted in Mainland China.

OBJECTIVES

To investigate the current status of overweight, obesity, and family function among children and adolescents in Chengdu, China, and to explore their associations.

METHODS

Children and adolescents in five primary and middle schools were chosen by cluster sampling. Body Mass Index was used to measure the status of overweight and obesity, and the Chinese family assessment instrument was adopted to assess family function. Latent profile analysis and stepwise logistic regression were applied to identify family classification and explore the relationships between family function and overweight/obesity.

RESULTS

A total of 7616 (84.92%) children and adolescents out of 8968 completed the study with qualified-filled questionnaires. Nine hundred and sixty-six (12.68%)participants were overweight and 656 (8.61%) were obese. The family function was categorized into three profiles: mild (63.93%), moderate (12.32%), and severe (23.75%) dysfunction. The prevalence of overweight was 12.16%, 14.71%, and 13.05% for mild, moderate, and severe family dysfunction, respectively. And the prevalence of obesity was 8.19%, 10.77%, and 8.62% respectively. Participants in moderate and severe dysfunction families were more likely to be overweight (moderate: OR = 1.27, 95% CI:1.01 ~ 1.59, P = 0.04; severe: OR = 1.38, 95% CI:1.15 ~ 1.66, P = 0.001) and obese (moderate: OR = 1.35, 95% CI:1.02 ~ 1.79, P = 0.03; severe: OR = 1.55, 95% CI:1.23 ~ 1.96, P < 0.001). Sociodemographic data such as gender, residence, grade, pocket money per week, the number of siblings, and the education level of the mother were all associated with the risk of being overweight/obese in children and adolescents.

CONCLUSIONS

The problems of being overweight or obese exist among children and adolescents in Chengdu. And the risk of being overweight or obese increases along with the decrease in family function.

Vegan Diets for Children: A Narrative Review of Position Papers Published by Relevant Associations

The scientific discourse on vegan diets for children and adolescents primarily involves referencing position statement papers from different scientific and professional organizations, including paediatric associations. Over the past two decades, specialized associations have issued official statements and published position papers about adopting well-designed vegan diets during crucial life stages, including pregnancy and lactation, infancy, and childhood. A subset of these associations firmly supports the notion that a well-designed vegan diet can indeed be healthy and support normal growth and development during particularly delicate life stages, emphasizing careful planning, vitamin B12 supplementation, and regular supervised medical and dietetics oversight. In contrast, specific paediatric associations caution against vegan diets for children and adolescents, citing potential harm and the lack of adequate substantiation. These criticisms in position papers frequently point to lower-quality studies and/or outdated studies. Additionally, concerns extend to comparing vegan and omnivorous diets, considering public health issues such as obesity and early stages of cardiovascular disease as well as the risk of prediabetes and type 2 diabetes. Notably, some scepticism stems from studies where children's adherence to a well-designed vegan diet is incomplete. Scientific rigor suggests performing a comparable assessment of omnivorous and vegan diets. This narrative review highlights the need for a comprehensive, up-to-date literature review to inform balanced perspectives on vegan diets for children and adolescents. Researchers and decision-makers should aim to actively improve the design and consistent implementation of both diet types.

Unhealthy weight among young children in the Middle East and North African region

OBJECTIVE

To understand early-life growth in the Middle East and North Africa (MENA) region, and how it has changed over time, we estimated the prevalence of wasting and overweight at ages under 5 years.

DESIGN

Cross-sectional data from twenty-nine Demographic and Health Surveys with direct anthropometric data and parent-reported demographic information were examined. The study utilised the WHO Child Growth Standards to classify overweight (weight-for-height z-score ≥ 2 sd above the median), wasting (weight-for-height z-score ≤ 2 sd below the median) and unhealthy weight defined as either wasting or overweight.

SETTING

Nationally representative for nine of the MENA countries (Armenia, Azerbaijan, Egypt, Jordan, Mauritania, Morocco, Tunisia, Turkey and Yemen).

PARTICIPANTS

Children under age 5 from nine MENA countries between 1987 and 2016 (n 155 961).

RESULTS

Across the region, at the most recent time point, between 7·3 and 23·6 % of children experienced unhealthy weight (Jordan - 7·3 %, Egypt -23·6 %); 1·7 and 16·6 % had wasting (Turkey, Yemen) and 2·0 and 15·0 % had overweight (Yemen, Egypt). Overweight was more common than wasting in all countries except Yemen and Mauritania. Between 1987 and 2016, the prevalence of unhealthy weight in the region increased (10·0-18·4 %) due to increases in both wasting and overweight. Boys had a higher prevalence of unhealthy weight than girls.

CONCLUSION

Undernutrition continues to be a problem in some countries in the MENA region, and overnutrition is emerging as a health concern in many countries in the region. Countries in the region must advance programmes that reduce undernutrition while not overlooking or inadvertently promoting overnutrition.

Estimating the effects of preventive and weight-management interventions on the prevalence of childhood obesity in England: a modelling study

BACKGROUND

The effects of the systematic delivery of treatments for obesity are unknown. We aimed to estimate the potential effects on the prevalence of childhood obesity of systematically offering preventive and treatment interventions to eligible children in England, based on weight or health status.

METHODS

For this modelling study, we developed a cross-sectional simulation model of the child and young adult population in England using data from multiple years of the Health Survey of England conducted between Jan 1, 2010, and Dec 31, 2019. Individuals were assessed for eligibility via age, BMI, and medical complications. Weight status was defined based on clinical criteria used by the UK National Institute of Health and Care Excellence. Published systematic reviews were used to estimate effect sizes for treatments, uptake, and completion for each weight-management tier. We used all available evidence, including evidence from studies that showed an unfavourable effect. We estimated the effects of two systematic approaches: a staged approach, in which children and young people were simultaneously given the most intensive treatment for which they were eligible, and a stepped approach, in which each management tier was applied sequentially, with additive effects. The primary outcomes were estimated prevalence of clinical obesity, defined as a BMI ≥98th centile on the UK90 growth chart, and difference in comparison with the estimated baseline prevalence.

FINDINGS

18 080 children and young people were included in the analytical sample. Baseline prevalence of clinical obesity was estimated to be 11·2% (95% CI 10·5 to 11·8) for children and young people aged 2-18 years. In modelling, we estimated absolute decreases in the prevalence of obesity of 0·9% (95% CI 0·1 to 1·8) for universal, preventive interventions; 0·2% (0·1 to 0·4) for interventions within a primary-care setting; 1·0% (0·1 to 2·1) for community and lifestyle interventions; 0·2% (0·0 to 0·4) for pharmaceutical interventions; and 0·4% (0·1 to 0·7) for surgical interventions. Staged care was estimated to result in an absolute decrease in the prevalence of obesity of 1·3% (-0·3 to 2·4) and stepped care was estimated to lead to an absolute decrease of 2·4% (0·1 to 4·8).

INTERPRETATION

Although individual effect sizes for prevention and treatment interventions were small, when delivered at scale across England, these interventions have the potential to meaningfully contribute to reducing the prevalence of childhood obesity.

FUNDING

UK National Institute for Health and Care Research.

Attrition rate and predictors of a monitoring mHealth application in adolescents with obesity

BACKGROUND

Integrating mobile health (mHealth) into paediatric obesity treatment can provide opportunities for more personalized and lifetime treatment. However, high attrition rates pose a significant challenge. The current study attempts to better understand attrition by exploring (1) attrition rates of a monitoring mHealth application for usage over 14 days and (2) testing predictors of attrition in adolescents with obesity.

METHODS

Participants were 69 adolescents between 12 and 16 years old who engaged in a multidisciplinary obesity treatment centre (either outpatient or inpatient) in two countries (Belgium and France). To assess the attrition rates, frequency distributions were used. To test the predictors of attrition, zero-inflated negative binomial regression was performed.

RESULTS

Attrition rates were high, in the outpatient group, more than half of the participants (53.3%) used the app for only 0-7 days. In the inpatient group, this percentage was 24.1%. Only deficits in initiating (a component of executive functions) were a negative predictor of attrition, indicating that deficits in initiating lead to lower attrition rates.

CONCLUSIONS

This study provides evidence for high attrition rates in mHealth interventions for adolescents with obesity and was the first to investigate psychological predictors of attrition to an mHealth monitoring tool in adolescents with obesity in treatment. Findings regarding predictors of attrition should be approached with caution due to the small sample size.

The Association of Adipokines and Myokines in the Blood of Obese Children and Adolescents with Lipoprotein Lipase rs328 Gene Variants

Obesity develops largely due to genetic factors, with the genetic polymorphism of lipid metabolism enzymes being of particular importance. However, it is still unclear how the genetic variants of one of the key enzymes in lipid transport, lipoprotein lipase (LPL), are associated with the endocrine function of mesenchymal tissues in obesity. The current study was aimed at the investigation of the LPL rs328 gene variant association with adipokines and myokines levels, as well as lipid metabolism indices in the blood of children and adolescents of both genders with obesity. We found that LPL polymorphism rs328 is not characterized by the differences in the levels of hormones, adipokines, and myokines and in the blood of healthy children and adolescents; however, it significantly affects these indices during obesity in gender-dependent manner. The shifts in hormones, adipokines, and myokines manifest mostly in the obese individuals with Ser447Ser genotype rather than with 447Ter genotype. Obese boys homozygous for Ser447Ser have more elevated leptin levels than girls. They also demonstrate lower adiponectin, apelin, prolactin, and osteocrine levels than those in obese girls with the same genotype. The gender-based differences are less pronounced in individuals with 447Ter genotype than in the homozygotes for 447Ser. Thus, we conclude that the polymorphism rs328 of the lipoprotein lipase gene is accompanied by the changes in hormones, adipokines, and myokines levels in the blood of children and adolescents with obesity in gender-dependent manner.

The association between body mass index elevation and differentiation in vitamin D receptor gene expression, genetic polymorphism, and oxidative stress in adult Egyptian individuals

Vitamin D plays a central role in maintaining calcium, phosphorus, and bone homeostasis in close interaction with the parathyroid hormone. Obesity is a significant health problem worldwide, particularly in developed nations. The current study was carried out to investigate the possible relationship between body mass index (BMI) elevation and differentiation in 25-hydroxyvitamin D (VD), vitamin D receptor (VDR) gene expression, and genetic polymorphism besides oxidative stress in adult Egyptian individuals. This was done to explore the mechanisms underlying the suggested role of the VD/VDR complex in the pathogenesis of obesity. A total of 70 subjects (30 obese, 25 overweight, and 15 normal, age: 20-50 years, without other chronic diseases) were selected. The study focused on the determination of VD, VDR gene polymorphism, VDR gene expression, alkaline phosphatase, calcium, phosphorus, glucose, lipid profile, oxidative stress including, oxidant (malondialdehyde), and anti-oxidants (reduced glutathione and superoxide dismutase). The results showed that elevation in BMI led to the percentage of the Ff 'allele' becoming predominant, while the percentage of the FF 'allele' was in the normal BMI range. Also, BMI elevation caused significant reductions in VD and VDR expression, with significant elevations in alkaline phosphatase and the levels of calcium and phosphate in serum. Also, oxidative stress increases with increasing BMI. Elevation in BMI causes a reduction in VD concentration and VDR gene expression levels. Also, the percentage of heterozygous mutant genotype Ff 'allele' is predominantly in the obese human, in contrast to normal subjects, where the percentage of homozygous wild genotype FF 'allele' is predominant. In general, the genetic expression and polymorphism of VD and VDR can be used as a genetic marker for predisposition, diagnosis, prognosis, and progression of obesity.

Oxidative stress in animal models of obesity caused by hypercaloric diets: A systematic review

Obesity is a global health difficulty characterized by an excessive accumulation of fat that increases body weight. Obesity has been studied in multiple animal models, of which those in which it is induced by diet stand out. Due to the increase in this condition, other mechanisms have been addressed that are triggered by states of overweight or obesity, such as the appearance of oxidative stress. These models aim to relate obesity caused by diet and how it influences the development of oxidative stress. In this study, a systematic review of the literature of 39 articles that studied obesity due to the consumption of hypercaloric diets and the appearance of oxidative stress in different animal models was carried out. This review identified the models with the most excellent use and the characteristics of the most appropriate diets to characterize states of oxidative stress due to obesity. In addition, the advantages and disadvantages of each model used are provided, as well as the techniques used for the assessment of obesity, and oxidative stress, providing the information in such a way that there is a general overview of the existing models of the parameters that allow to adequately establish both variables studied, providing information that allows the researcher to choose the appropriate model and factors according to the interest and objectives of the present research.

An early-life microbiota metabolite protects against obesity by regulating intestinal lipid metabolism

The mechanisms by which the early-life microbiota protects against environmental factors that promote childhood obesity remain largely unknown. Using a mouse model in which young mice are simultaneously exposed to antibiotics and a high-fat (HF) diet, we show that Lactobacillus species, predominant members of the small intestine (SI) microbiota, regulate intestinal epithelial cells (IECs) to limit diet-induced obesity during early life. A Lactobacillus-derived metabolite, phenyllactic acid (PLA), protects against metabolic dysfunction caused by early-life exposure to antibiotics and a HF diet by increasing the abundance of peroxisome proliferator-activated receptor γ (PPAR-γ) in SI IECs. Therefore, PLA is a microbiota-derived metabolite that activates protective pathways in the small intestinal epithelium to regulate intestinal lipid metabolism and prevent antibiotic-associated obesity during early life.

Randomised controlled trial of exercise training during lactation on breast milk composition in breastfeeding people with overweight/obesity: a study protocol for the MILKSHAKE trial

Breast milk from people with overweight/obesity may differ in composition compared with that from normal-weight people. Exercise training can modify breast milk composition in rodent models, with a beneficial impact demonstrated on the offspring's metabolism, but whether these findings translate to humans is unclear. This trial aims to determine the effect of an exercise intervention on breast milk composition and whether an exercise-induced modification of breast milk impacts the infants' growth and body composition. Effect of Exercise Training on Breastmilk Composition is a randomised, controlled trial with two parallel groups, one exercise group and one control group, with a 1:1 allocation. We will include a minimum of 62 exclusively breastfeeding participants, 6 weeks postpartum. The exercise intervention lasts 8 weeks and comprises 25 supervised endurance exercise sessions with moderate or high intensity. The primary outcome measure is the change in the relative concentration of the human milk oligosaccharide 3'sialyllactose in breast milk from baseline at 6 weeks postpartum to the end of the intervention period. Secondary outcomes include breast milk concentrations of other metabolites, cytokines, hormones and microRNA, maternal health outcomes, infant growth, infant gut microbiome and infant circulating microRNA. Maternal and infant outcomes will be measured before, during and after the intervention period, with a follow-up of the infants until they are 24 months old. Trial registration number NCT05488964.

Vitamin D deficiency in adolescents with obesity - Altered metabolism or environmental factors?

Introduction

Introduction: obesity childhood is related to vitamin D deficiency. The aim of this study was to compare vitamin D status between adolescents with obesity living in an urban area and in a rural area. We hypothesized that environmental factors would be decisive in reducing the body content of vitamin D in patients with obesity. Methods: a cross-sectional clinical and analytical study (calcium, phosphorus, calcidiol and parathyroid hormone) was carried out in a group of 259 adolescents with obesity (BMI-SDS > 2.0), 249 adolescents with severe obesity (BMI-SDS > 3.0) and 251 healthy adolescents. The place of residence was categorized as urban or rural. Vitamin D status was defined according to the US Endocrine Society criteria. Results: vitamin D deficiency was significantly higher (p < 0.001) in severe obesity (55 %) and obesity groups (37.1 %) than in the control group (14 %). Vitamin D deficiency was more frequent in severe obesity (67.2 %) and obesity groups (51.2 %) living in urban areas than in those living in rural areas (41.5 % and 23.9 %, respectively). The patients with obesity living in urban residence did not present significant seasonal variations in vitamin D deficiency in contrast to those patients with obesity living in rural residence. Conclusions: the most probable mechanism for vitamin D deficiency in adolescents with obesity, rather than altered metabolic is the environmental factors (sedentary lifestyle and lack of adequate sunlight exposure).

Krill oil inhibited adipogenic differentiation by inducing the nuclear Nrf2 expression and the AMPK activity

The current study investigated the antiadipogenic mechanism of krill oil from the 3T3-L1 adipocytes. The krill oil adhered to the criteria as a food standard by showing 50.8% of the total phospholipid, 5.27% myristic acid, and 1.63% linoleic acid. The lipid accumulation that was measured in the 3T3-L1 cells using oil red O staining was reduced up to 54% by the krill oil. The krill oil treatment reduced the adipogenic transcription factors by downregulating the sterol regulatory element binding protein 1 (SREBP1) and acetyl-CoA carboxylase (ACC), phospho-ACC, and AMP-activated protein kinase (AMPK) phosphorylation. The current study confirmed that the krill oil inhibited adipogenesis by downregulating SREBP1 and ACC via the upregulation of the AMPK and nuclear factors E2-related factor 2 (Nrf2) signaling pathway in the 3T3-L1 adipocytes. These findings suggest that krill oil is a good source of phospholipid and phosphatidylcholine, which could be a potential natural antiobesity ingredient by inhibiting adipogenesis.

Strengthening Community Roots: Anchoring Newcomers in Wellness and Sustainability (SCORE!): A protocol for the co-design and evaluation of a healthy active living program among a newcomer community in Canada

BACKGROUND

The burden of childhood obesity and cardiometabolic risk factors affecting newcomer Canadians living in lower socioeconomic circumstances is a concerning public health issue. This paper describes Strengthening Community Roots: Anchoring Newcomers in Wellness and Sustainability (SCORE!), an academic-community research partnership to co-design interventions that nurture and optimize healthy activity living (HAL) among a community of children and families new to Canada in Hamilton, Ontario, Canada.

METHODS/DESIGN

Our overarching program is informed by a socio-ecological model, and will co-create HAL interventions for children and families new to Canada rooted in outdoor, nature-based physical activity. We will proceed in three phases: Phase 1) synthesis of existing evidence regarding nature based HAL interventions among children and families; Phase 2) program development through four data collection activities including: i) community engagement activities to build trustful relationships and understand barriers and facilitators, including establishing a community advisory and action board, qualitative studies including a photovoice study, and co-design workshops to develop programs; ii) characterizing the demographics of the community through a household survey; iii) characterizing the built environment and HAL programs/services available in the community by developing an accessible real-time systems map; and iv) reviewing municipal policies relevant to HAL and sustainability; leading to Phase 3) implementation and evaluation of the feasibility of co-designed HAL programs.

CONCLUSION

The etiology of childhood obesity and related chronic diseases is complex and multifactorial, as are intervention strategies. The SCORE! program of research brings together partners including community members, service providers, academic researchers, and organizational leaders to build a multi-component intervention that promotes the health and wellness of newcomer children and families.

Association between Dietary Behavior and Overweight and Obesity among Chinese Students: A Cross-Sectional Study

OBJECTIVES

To investigate the prevalence of overweight and obesity among Ningbo students and explore the association between students' dietary behavior and overweight and obesity.

MATERIALS AND METHODS

A total of 7299 students were recruited, including 3755 males and 3544 females. A questionnaire on student health status and influencing factors was used to investigate dietary behavior. Logistic regression analysis investigated the relationship between dietary behavior and overweight and obesity. Age, gender, area, grade, sleep duration, and physical activity were adjusted in the multivariate regression models.

RESULTS

This study revealed that the prevalence of overweight and obesity in Ningbo students was 16.14% and 9.88%, respectively. The logistic regression analysis results showed that regular consumption of sugary beverages was associated with a higher risk of being overweight (OR = 1.256, 95% CI: 1.023-1.542, p = 0.029). The research indicated that skipping breakfast was considered a risk factor for obesity (OR = 2.102, 95% CI: 1.087-4.065, p = 0.027). After adjusting for age, gender, area, and grade and continuing to adjust for sleep duration and physical activity, the results showed that consuming fried food at least once a day increased the risk of obesity (OR = 1.494, 95% CI: 1.050-2.125, p = 0.026; OR = 1.516, 95% CI: 1.065-2.158, p = 0.021, respectively). This study found that the frequency of breakfast and the consumption of fried food, fresh vegetables, and fruits were not significantly associated with being overweight (p > 0.05).

CONCLUSIONS

This study indicated that dietary behavior was related to overweight and obesity among Ningbo students. Further studies and more government support are required to confirm this study's findings and address the current overweight/obesity problems.

Association of Sugar-Sweetened Beverage Consumption and Moderate-to-Vigorous Physical Activity with Childhood and Adolescent Overweight/Obesity: Findings from a Surveillance Project in Jiangsu Province of China

Sugar-sweetened beverage (SSB) consumption and inadequate moderate-to-vigorous physical activity (MVPA) have been suggested as potential contributors to overweight/obesity during childhood or adolescence; however, the results of previous studies are inconsistent. It was crucial to estimate the independent and joint association of SSB consumption and inadequate MVPA for childhood and adolescent overweight/obesity. The "Surveillance for Common Disease and Health Risk Factors Among Students in Jiangsu Province 2021-2022" initiative provided us with representative population-based data that we studied. SSB consumption and inadequate MVPA were determined by self-reported SSB habit and MVPA frequency (days/week). The body mass index for each gender and age subgroup was used to identify those who were overweight or obese. With stratified analyses to ascertain differences in age or gender, we employed the logistic regression model to assess the association of SSB and MVPA with overweight/obesity and applied the likelihood ratio test to explore the interactions. Approximately 38.2% of the study population (119,467 students aged 8-17) were overweight/obese. After adjusting covariates, SSB consumption or inadequate MVPA was associated with overweight/obesity (OR = 1.05, 95% CI = 1.02-1.07; and OR = 1.07, 95% CI = 1.03-1.10). In comparison to students with "no SSB consumption and adequate MVPA", those with "SSB consumption and inadequate MVPA" had a higher risk of being overweight/obese (OR = 1.13, 95% CI = 1.08-1.18). Regardless of age and gender subgroups, the correlation of SSB and MVPA alone and together with being overweight/obese was generally similar, with the adolescent group aged 13-17 years (OR = 1.15, 95% CI = 1.09-1.22) and females (OR = 1.09, 95% CI = 1.02-1.17) being more susceptible. Moreover, there was a significant interaction between SSB consumption and gender (p < 0.001), as well as between SSB consumption and inadequate MVPA (p = 0.008). Hence, SSB consumption in students is significantly associated with overweight/obesity, especially when MVPA is inadequate. In light of the rapidly expanding childhood and adolescent obesity epidemic, proper attention should be given to these modifiable behaviors, particularly SSB and MVPA.

Mapping of nutrition policies and programs in South Asia towards achieving the Global Nutrition targets

BACKGROUND

South Asia continues to host the triple burden of child malnutrition with high levels of child undernutrition, hidden hunger (micronutrient deficiencies) and childhood overweight/obesity. To combat malnutrition, the international community along with the National governments have launched initiatives to track the country's progress towards achieving the Global Nutrition targets by 2025. This review captures the country-specific efforts of nutrition-specific and nutrition-sensitive sectoral programs and policies towards achieving these targets for eight South Asian countries.

METHODS

A systematic internet search was undertaken to search relevant policies and programs from Government websites and twelve International Organisations working in the region. The authors developed a template to map the policies against the following criteria: (i) enabling supportive environment; (ii) Initiatives targeted at nutrition-specific interventions; and (iii) Initiatives targeted at nutrition-specific interventions that impact child malnutrition. A narrative descriptive approach was used to present findings.

RESULTS

All eight countries had relevant policies and programs to address child malnutrition and macronutrient deficiencies with targets for significant reductions in stunting and improved breastfeeding. However, despite the outlined there are major challenges of implementation, monitoring, evaluation and quality that persist with increased dependency on international donors and organisations for funding and/or implementation of nutrition plans.

CONCLUSION

There is a need to contextualise efforts designated to donors and governments to improve the tracking of efforts that impact nutrition.

Progression to Obesity: Variations in Patterns of Metabolic Fluxes, Fat Accumulation, and Gastrointestinal Responses

Obesity is a multifactorial disorder that is remarkably heterogeneous. It presents itself in a variety of phenotypes that can be metabolically unhealthy or healthy, associate with no or multiple metabolic risk factors, gain extreme body weight (super-responders), as well as resist obesity despite the obesogenic environment (non-responders). Progression to obesity is ultimately linked to the overall net energy balance and activity of different metabolic fluxes. This is particularly evident from variations in fatty acids oxidation, metabolic fluxes through the pyruvate-phosphoenolpyruvate-oxaloacetate node, and extracellular accumulation of Krebs cycle metabolites, such as citrate. Patterns of fat accumulation with a focus on visceral and ectopic adipose tissue, microbiome composition, and the immune status of the gastrointestinal tract have emerged as the most promising targets that allow personalization of obesity and warrant further investigations into the critical issue of a wider and long-term weight control. Advances in understanding the biochemistry mechanisms underlying the heterogenous obesity phenotypes are critical to the development of targeted strategies to maintain healthy weight.

Epidemiological Impact of Metabolic Syndrome in Overweight and Obese European Children and Adolescents: A Systematic Literature Review

The prevalence of overweight and obesity is continuously increasing, both in the adult and pediatric populations, posing a substantial challenge to public health. Understanding the epidemiological burden of metabolic syndrome (MetS) among children, particularly regarding its complications and long-term effects in adulthood, is crucial for identifying effective preventive measures and enhancing the clinical care of obese children. Therefore, by searching two databases, a systematic review was conducted in order to evaluate studies that specifically addressed the epidemiological MetS impact among overweight/obese European children and adolescents. Overall, 15 studies were considered. The epidemiological data concerning the MetS impact were contingent on the diagnostic criteria used and varied across countries, resulting in a prevalence range of 1.44% to 55.8%. Spanish studies were the most numerous (34%), revealing a country prevalence rate ranging from 2.5% to 19.6%. Males (prevalence range: 1.4-55.8%) and subjects with overweight/obesity (prevalence range: 12.9-55.8%) were mainly affected. Obesity emerged as the main risk factor in the MetS development and the consequent onset of cardiovascular complications and diabetes. Knowing the MetS burden and its risk factors could improve their prevention, detection, and treatment, and guide the development of targeted public health interventions to appropriately address the health needs of younger patients.

Meteorin-like Protein and Asprosin Levels in Children and Adolescents with Obesity and Their Relationship with Insulin Resistance and Metabolic Syndrome

OBJECTIVE

Two newly discovered adipokines, including Meteorin-like protein (Metrnl) and asprosin, have been implicated in glucose and insulin metabolism. This study aimed to investigate the associations of these adipokines with obesity in children and adolescents.

METHODS

This study was performed on 35 normal-weight children and 35 children with obesity. Anthropometric and biochemical parameters were determined. Serum concentrations of Metrnl, asprosin, and insulin were measured using enzyme-linked immunosorbent assay.

RESULTS

Metrnl level was significantly lower in obese children than normal-weight children. Additionally, Metrnl was negatively correlated with body mass index (BMI), insulin, waist-to-hip ratio, and homeostatic model assessment of insulin resistance (HOMA-IR). Our results also revealed that circulating asprosin levels were significantly increased in obese children compared to the control subjects and were positively correlated with BMI, insulin, HOMA-IR, cholesterol, and LDL-C.

CONCLUSION

Obesity is accompanied by significant alterations in Metrnl and asprosin and therefore these adipokines, especially Metrnl, are suggested as new promising therapeutic targets for obesity and its associated metabolic imbalances.

Relationship of body mass index to percent body fat determined by deuterium isotopic dilution and impedancemetry among Tunisian schoolchildren

Objectives

This study aims to evaluate the relation of body mass index (BMI) to fat mass among children by two techniques impedancemetry and deuterium oxide dilution (D2O).

Methods

This study was carried out in 156 schoolchildren aged between 8 and 11 years. The children received interrogation specifying lifestyle and food habits. Body composition was determined using the impedancemetry and D2O technique.

Results

The results showed a difference between the percentage of obese and overweight children according to BMIZ classification (30.1%), bioelectrical impedance method (14.7%) and D2O technique (42.9%). Despite the difference between the last two classifications, we found a significant correlation between body fat percentages determined by impedancemetry and D2O technique (r = 0.695, p<0.01). Bioelectrical impedance analysis underestimated %BF by 78.02% in overall children, by 70.05% in boys and by 84.73% in girls compared to D2O technique.

Conclusion

This study has demonstrated that the percentage of overweight and obesity varied according the methods used. Further development of body composition methods is needed in children for the real determination of the obesity prevalence and therefore a better monitoring of this public health problem.

Higher serum uric acid is associated with body fat, retinol-binding protein 4, and antioxidative status in Brazilian children

OBJECTIVE

The aim of this study was to evaluate the association of serum uric acid (SUA) with adiposity, adipokines, and anti- and oxidative markers in Brazilian children.

METHODS

This was a cross-sectional investigation with 378 children ages 8 to 9 y in Viçosa, Minas Gerais, Brazil. Information on sociodemographic and lifestyle characteristics was obtained via questionnaires, and body fat was determined by dual energy x-ray absorptiometry. We compared the distributions of adiposity (total and central), adipokines (adiponectin, chemerin, leptin, and retinol-binding protein 4 [RBP4]), anti- and oxidative markers (plasma ferric reducing antioxidant power [FRAP], superoxide dismutase [SOD], and malondialdehyde [MDA]) by SUA categories using linear regression.

RESULTS

SUA was positively associated with total and central fat. Every standard deviation (SD) of SUA was related, respectively, to a 3.4 (95% confidence interval [CI], 2.4-4.4), 4 (95% CI, 2.8-5.1), 4.2 (95% CI, 2.9-5.5), and 3.5 (95% CI, 2.4-4.6) units higher of total, truncal, android, and gynoid fat. We found a positive association of SUA with RBP4 and FRAP, and a negative association with MDA. Every SD of SUA was related, respectively, to 0.1 (95% CI, 0.01-0.1) and 7.8 (95% CI, 5.5-10.1) units higher of RBP4 and FRAP; and to -0.3 (95% CI, -0.5 to -0.1) units lower of MDA.

CONCLUSIONS

SUA was positively associated with adiposity, RBP4, and antioxidative status in Brazilian children.

Small for gestational age preterm infants and later adiposity and height: A systematic review and meta-analysis

BACKGROUND

Overweight and obesity and their consequent morbidities are important worldwide health problems. Some research suggests excess adiposity origins may begin in fetal life, but unknown is whether this applies to infants born preterm.

OBJECTIVE

The objective of the study was to assess the association between small for gestational age (SGA) birth and later adiposity and height among those born preterm.

DATA SOURCES

MEDLINE, EMBASE and CINAHL until October 2022.

STUDY SELECTION AND DATA EXTRACTION

Studies were included if they reported anthropometric (adiposity measures and height) outcomes for participants born preterm with SGA versus non-SGA. Screening, data extraction and risks of bias assessments were conducted in duplicate by two reviewers.

SYNTHESIS

We meta-analysed across studies using random-effects models and explored potential heterogeneity sources.

RESULTS

Thirty-nine studies met the inclusion criteria. In later life, preterm SGA infants had a lower body mass index (-0.66 kg/m2 , 95% CI -0.79, -0.53; 32 studies, I2  = 16.7, n = 30,346), waist circumference (-1.20 cm, 95% CI -2.17, -0.23; 13 studies, I2  = 19.4, n = 2061), lean mass (-2.62 kg, 95% CI -3.45, 1.80; 7 studies, I2  = 0, n = 205) and height (-3.85 cm, 95% CI -4.73, -2.96; 26 studies, I2  = 52.6, n = 4174) compared with those preterm infants born non-SGA. There were no differences between preterm SGA and preterm non-SGA groups in waist/hip ratio, body fat, body fat per cent, truncal fat per cent, fat mass index or lean mass index, although power was limited for some analyses. Studies were rated at high risk of bias due to potential residual confounding and low risk of bias in other domains.

CONCLUSIONS

Compared to their preterm non-SGA peers, preterm infants born SGA have lower BMI, waist circumference, lean body mass and height in later life. No differences in adiposity were observed between SGA preterm infants and non-SGA preterm infants.

Every cockroach is beautiful to his mother's eyes"? A multicentric study on the perception of child's health status according to the parent

Introduction

Childhood obesity is a social health problem in the Western World and an important goal is to analyze and correct risk factors. However, part of the problem could be determined by a different perception of the weight.

Material and methods

In October 2019, we conducted a cross-sectional study in which a questionnaire was administered to the parents of primary and secondary school children in South-East Tuscany, Italy. The aim was to determine the association between children's Body Mass Index (BMI) and the parent's perception.

Results

Analysis was carried out on 1,405 complete questionnaires. We found that most parents wrongly perceive the weight of their children. 88.3% of parents with obese children believe that their children are of normal weight or only "a little overweight". 67.6% of parents who have overweight children think that their children are of normal weight (p < 0.001).

Conclusions

Our results show a misperception of the weight of the children in the parents eyes. The acquisition of healthy behaviour during childhood is extremely important for health in adulthood and for avoiding the onset of associated diseases. Therefore, food education becomes a crucial objective. Children and parents need to increase consciousness of the correct weight and diseases resulting from bad nutrition.

The skeletal and dental age advancements of children and adolescents with overweight and obesity: A systematic review and meta-analysis

INTRODUCTION

Over the past decades, a trend of increasing obesity among children has emerged. This study aimed to evaluate and summarize the impacts of overweight and obesity on children's and adolescents' skeletal and dental developmental advancement that may influence orthodontic management.

METHODS

Registered with the Prospective Register of Systematic Reviews (registration no. CRD42022347488), this study complies with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Particularly, relevant original studies on skeletal or dental age evaluation were screened from accessible electronic databases and supplemented by hand-searching. Meta-analysis was recruited to calculate differences (and their 95% confidence interval [CI]) between subjects with overweight or obese and normal-weight counterparts.

RESULTS

After applying the inclusion and exclusion criteria, 17 articles were selected for the final review. Two of the 17 selected studies were found to have a high risk of bias and moderate the other 15. A meta-analysis detected no statistically significant difference in skeletal age between children and adolescents with overweight and normal-weight counterparts (P = 0.24). However, the dental age of children and adolescents with overweight was found to be 0.49 years (95% CI, 0.29-0.70) advanced in comparison with normal-weight counterparts (P <0.00001). In contrast, children and adolescents with obesity were found to have advanced skeletal age by 1.17 (95% CI, 0.48-1.86) years (P = 0.0009) and dental age by 0.56 (95% CI, 0.37-0.76) years (P <0.00001) compared with their normal-weight counterparts.

CONCLUSION

Because the orthopedic outcomes of the orthodontic intervention are closely tied to the skeletal age of the patients, these results suggest that the orthodontic evaluation and treatment of children and adolescents with obesity might occur earlier than that of the normal-weight population.

Monitoring Food Marketing Directed to Portuguese Children Broadcasted on Television

Children are massively exposed to food marketing through television and other forms of media. Marketing strategies promote unhealthy eating behaviours and contribute to childhood obesity. The main aim of this study was to assess the potential exposure and power of food advertisements aimed at children, broadcasted on Portuguese television. Television data was recorded for two weekdays and two weekend days between 6 am and 10 pm during November 2021 from four free-access Portuguese television channels. Data was analysed according to the World Health Organization television protocol and Portuguese Legislation. We identified 5272 advertisements, of which 11.2% were for food and beverages (n = 590). Most advertised food categories for children and adolescents were chocolate and bakery products (42.0%), soft drinks (26.7%), and yoghurt (16.0%), and none met the nutritional profile outlined by the national legislation. Unhealthier food advertisements targeting youth were shown in children's non-peak time and morning during news and entertainment programmes. Product uniqueness, humour, and fun were the most frequent primary persuasive techniques. Most advertisements showed a high use of brand logos, product images, and premium offers. In conclusion, Portuguese children and adolescents are potentially exposed to large numbers of unhealthy food advertisements on television, despite marketing regulation and restriction policies.

Metabolic risk factors in prepubertal and pubertal patients with overweight and obesity

OBJECTIVES

Metabolic syndrome (MetS) is a cluster of conditions linked to obesity that increases cardiovascular risk. We evaluated the frequency of clinical abnormalities associated with overweight and obesity in childhood, to determine whether a diagnosis of MetS is appropriate in this population.

METHODS

Cross-sectional study with 116 pubertal and prepubertal children with a mean age (SD) of 10.9 (2.5) years, with overweight and obesity. We defined MetS using the International Diabetes Federation criteria, regardless of the age.

RESULTS

45 patients met the criteria, 20 had at least one metabolic abnormality in addition to a high waist circumference (WC), and seven with WC below percentile 90th, had at least one metabolic abnormality. The prepubertal had higher zBMI [3.1 (2.6-3.8) vs. 2.8 (2.4-3.3); p=0.037], less lean body mass (kg) [27.13 (7.3) vs. 34.13 (9.8); p=0.005] and a similar frequency of non-alcoholic fatty liver disease (NAFLD) compared to the pubertal [44.7 vs. 35.9; p=0.323]. Prepubertal with NAFLD had higher zBMI, lower HDL levels, higher TG/HDL ratios and higher fat percentages; while pubertal with NAFLD had higher WC/height, aspartate aminotransferase and oxaloacetic transaminase.

CONCLUSIONS

The diagnosis of MetS in childhood is not fundamental. Individualized management, focusing on the earliest age groups, in which we identified a more severe degree of obesity, should be done. We also recommend screening for NAFLD in all ages, due to the high prevalence observed.

Altered insulin secretion dynamics relate to oxidative stress and inflammasome activation in children with obesity and insulin resistance

BACKGROUND

Insulin resistance (IR) is considered the main driver of obesity related metabolic complications, and is related to oxidative stress and inflammation, which in turn promote each other. There is currently no specific definition of IR in children, rather, that for adult population is used by pediatric endocrinologists instead. Altered insulin secretion dynamics are associated with worse metabolic profiles and type 2 diabetes mellitus development, thus we aimed to test whether insulin response relates to oxidative stress and inflammation in children.

METHODS

We conducted a case-control study, including 132 children classified as follows: 33 children without obesity (Lean); 42 with obesity but no IR according to the American Diabetes Association criteria for adults (OBIR-); 25 with obesity and IR and an early insulin response to an oral glucose tolerance test (OGTT) (EP-OBIR +); 32 with obesity, IR, and a late insulin peak (LP-OBIR +); and studied variables associated with lipid and carbohydrate metabolism, oxidative stress, inflammation and inflammasome activation.

RESULTS

The measured parameters of children with obesity, IR, and an early insulin response were similar to those of children with obesity but without IR. It was late responders who presented an impaired antioxidant system and elevated oxidative damage in erythrocytes and plasma, and inflammasome activation at their white blood cells, despite lower classical inflammation markers. Increased uric acid levels seems to be one of the underlying mechanisms for inflammasome activation.

CONCLUSIONS

It is insulin response to an OGTT that identifies children with obesity suffering oxidative stress and inflammasome activation more specifically. Uric acid could be mediating this pathological inflammatory response by activating NLRP3 in peripheral blood mononuclear cells.

Effects of Aerobic Exercise on Serum Adiponectin Concentrations in Children and Adolescents with Obesity: A Systematic Review and Meta-Analysis

Serum adiponectin plays a vital role in various physiological processes, such as anti-inflammatory, anti-atherosclerotic, anti-apoptotic and pro-angiogenic activities. Any abnormalities in its concentration can lead to adverse health outcomes, particularly in children and adolescents. Therefore, it is crucial to investigate factors influencing serum adiponectin concentrations in this population. The primary objective of this study was to systematically evaluate the impact of aerobic exercise on serum adiponectin concentrations in children and adolescents with obesity. To achieve this, a comprehensive literature search was conducted up to January 2023, utilising five databases: PubMed, Web of Science, Embase, Cochrane Library and Clinicaltrial.gov. The inclusion criteria involved studies that focused solely on aerobic exercise as an intervention for children and adolescents with obesity. Only studies that reported outcome indicators related to serum adiponectin were considered for analysis. The quality of the included studies was assessed using the Cochrane Risk of Bias (ROB) assessment tool, and statistical analysis was performed using RevMan 5.4.1 analysis software. This meta-analysis incorporated data from eight trials, involving a total of 272 subjects. The results demonstrated that aerobic training significantly increased serum adiponectin concentrations [standardized mean difference (SMD) = 0.85; 95% confidence interval (CI) = 0.33 to 1.37; I2 = 0%; p = 0.001] in children and adolescents with obesity when compared to non-exercise controls. Furthermore, the magnitude of this effect appears to be influenced by the intensity of aerobic exercise, with higher-intensity aerobic exercise resulting in greater increases in serum adiponectin concentrations.

Measured vs estimated resting energy expenditure in children and adolescents with obesity

Pediatric obesity requires early targeted interventions consisting mainly of a low-calorie diet prescribed based on resting energy expenditure (REE), often estimated through predictive equations. The aim of this study was to define the prevalence of "hypo-", "normo-" and "hypermetabolic" in a large cohort of children and adolescents with obesity by comparing measured and estimated REE and to evaluate the characteristics related to these metabolic statuses in both males and females. The study population was divided into the three subgroups by comparing REE measured using indirect calorimetry and estimated using the Molnar equation, and subsequently analyzed. The majority of the participants (60.6%) were normometabolic, 25.5% hypermetabolic and 13.9% hypometabolic. No significant differences in age, Tanner stage, systolic blood pressure, or the presence of metabolic syndrome were found. However, the hypermetabolic subgroup was significantly lighter, shorter, with lower hip and waist circumferences, had a greater amount of fat-free mass and lower fat mass, significantly lower diastolic blood pressure, and a significantly higher frequency of non-alcoholic liver steatosis. Pediatric obesity is more associated with normal or increased REE than with a hypometabolic condition, suggesting that estimation of energy expenditure with predictive equations is still inadequate for prescribing the appropriate diet plan.

Prevalence of Obesity and Its Relationship With Hypertension Among School-Going Adolescents Aged 12-16 Years

BACKGROUND

Childhood obesity is a significant health issue that has grown in prominence, particularly in developed countries. Primary hypertension has become the dominant cause, leading to an increased incidence of arterial hypertension. This study examined the associations between sex and obesity with hypertension (HTN). Understanding these associations can provide insights into the risk factors and potential preventive strategies for HTN.

MATERIALS AND METHODS

This cross-sectional observational study was conducted at private schools in Chennai, Tamil Nadu, India, for one year. Data analysis was performed on a cohort of participants who underwent health assessments, including blood pressure measurements, self-reported dietary habits, and socio-economic status information. Statistical analyses assessed the associations between sex, dietary habits, socio-economic status, and HTN.

RESULTS

There were 255 (51.0%) males and 245 (49%) females. Among the female participants, only two individuals (0.8%) had HTN, while among males, 11 individuals (4.3%) had HTN, indicating a significant association between sex and HTN (P=0.014). In terms of dietary habits, the prevalence of HTN was similar among non-vegetarians (2.5%) and vegetarians (3.1%), and the association was not statistically significant (P=0.777). Among the obese individuals in the study population, eight individuals (8.8%) had HTN, while the remaining 83 individuals (91.2%) did not have HTN, with a P-value of <0.0001, which indicates a significant association between HTN and obesity.

CONCLUSION

This study revealed a significant association between sex and HTN, with males exhibiting a higher prevalence of HTN than females. Furthermore, the study showed a significant association between obesity and hypertension, indicating that obese individuals were more likely to have HTN.

Prevalence of Overweight and Obesity Among Students of Government and Private High Schools in an Indian State With Significant Tribal Population: A Cross-Sectional Analytical Study

BACKGROUND

Overweight and obesity among school-going children is an emerging public health problem in the country. The information available on the true extent of obesity and overweight among school-aged children is limited. Hence, the present study has been conducted to determine the prevalence of overweight and obesity among high school students in Jharkhand, India.

METHODOLOGY

This was a cross-sectional study conducted among 1162 students of government and private schools of Ormanjhi block, Ranchi district, from July 2022 to December 2022. A predesigned, semi-structured, pre-tested questionnaire containing different sections namely sociodemographic characteristics, and health parameters were used for the study subjects. Clinical examination and anthropometric measurements of height, weight, and waist and hip circumferences were taken using standard equipment to calculate body mass index (BMI) and central obesity (waist-hip ratio).

RESULTS

The prevalence of overweight and obesity was more at 14 years of age (30.2%), among boys (18.1%), and among students practicing the Islam religion (51.1%). Moreover, the prevalence of overweight and obesity was found to be highest in private schools (66.2%), and that was statistically significant (p<0.001).

CONCLUSION

The prevalence of overweight and obesity was found to be significant with respect to age, gender, and religion. The findings from this study would be helpful in raising awareness among students, parents, teachers, and health professionals about the influence of overweight and obesity on a child's physical, social, and psychological well-being, and this, in turn, would facilitate parents, students, and teachers in the adoption of a healthy lifestyle.

Family economic trajectories and body mass index in Indonesia: Evidence from the Indonesian Family Life Surveys 2 to 5

Indonesia faces the double burdens of childhood obesity and malnutrition. A family's socioeconomic status has been suggested to be one of the most influential factors contributing to childhood nutritional problems. This study aimed to: 1) identify the distinct trajectories of family economics; and 2) assess whether a family's economic trajectory influences children's body mass index (BMI). We analyzed trajectory patterns of family economic levels from 1997 to 2015 among 846 children aged under 3 years in 1997 using data from Indonesian Family Life Surveys. Trajectory patterns were identified with Group-Based Trajectory Modeling using the traj plug-in in STATA software. The BMI was classified according to 2007 World Health Organization growth standards. Adjusted relative risk ratios (aRRRs) of family economic level trajectories and children's BMI were calculated using multinomial logistic regressions. We identified three distinct trajectories of family economic level: stable poorest, stable middle, and increasing richest. In the total sample, there were no significant relationships between a family's income trajectory and children's BMI in the adjusted models. A significant relationship existed for male children, but not for female children, of compared to the poorest family trajectory group, male children in the increasing richest trajectory group were more likely to be overweight/obese (aRRR 6.1, 95% confidence interval: 1.22-30.62) after adjusting for age and BMI. The present results highlight the importance of early interventions to minimize the potential adverse impacts of excessive BMI later in adulthood.

Improved Insulin Secretion Response and Beta-cell Function Correlated with Increased Prolactin Levels After Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients with Acanthosis Nigricans

OBJECTIVE

To explore insulin secretion patterns, β-cell function, and serum prolactin (PRL) concentrations in Chinese morbidly obese patients with Acanthosis nigricans (AN) and their alterations after laparoscopic sleeve gastrectomy (LSG).

METHODS

A total of 138 morbidly obese subjects undergoing LSG were categorized as simple obesity without AN (OB group, n = 55) and obesity with AN (AN group, n = 83). Oral glucose tolerance test (OGTT), PRL, and related metabolic indices were performed pre- and 12 months post-LSG. Insulin secretion patterns were derived from insulin secretion peak time during OGTT: type I (peak at 30 or 60 min) and type II (peak at 120 or 180 min).

RESULTS

Preoperatively, AN group showed significantly higher proportions of type II insulin secretion pattern, fasting insulin (FINS), and homeostatic model assessment of insulin resistance (HOMA-IR) whereas lower oral glucose insulin sensitivity (OGIS), insulinogenic index (IGI), and disposition index (DI) than OB group, which were improved significantly at 12 months postoperatively in both groups, more pronounced in AN group. Intriguingly, serum PRL declined substantially in AN group than OB group at baseline whereas elevated only in the AN group post-LSG. After adjusting for confounding factors, elevated PRL correlated significantly with increased IGI and DI, and decreased HOMA-IR in both genders, as well as increased OGIS in females, which was detected only in the AN group CONCLUSION: Morbidly obese patients with AN presented delayed insulin secretion response, impaired insulin secretion, and β-cell dysfunction, which were significantly improved by LSG and might benefit from elevated PRL.

Obesity-Related Atrial Fibrillation: Cardiac Manifestation of a Systemic Disease

Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with increased morbidity and mortality. The mechanisms underlying AF are complex and multifactorial. Although it is well known that obesity is a strong risk factor for AF, the mechanisms underlying obesity-related AF are not completely understood. Current evidence proposes that in addition to overall hemodynamic changes due to increased body weight, excess adiposity raises systemic inflammation and oxidative stress, which lead to adverse atrial remodeling. This remodeling includes atrial fibrosis, atrial dilation, decreased electrical conduction between atrial myocytes, and altered ionic currents, making atrial tissue more vulnerable to both the initiation and maintenance of AF. However, much remains to be learned about the mechanistic links between obesity and AF. This knowledge will power the development of novel diagnostic tools and treatment options that will help combat the rise of the global AF burden among the obesity epidemic.

Maternal Prenatal Factors and Child Adiposity in Associations with Cardiometabolic Risk Factors in Term-Born Chinese Children at the Age of 2 Years

Early growth has long-lasting associations with adult metabolic health. However, the association of adiposity with cardiometabolic risk factors in toddlers remains poorly understood. This study aimed to examine the association of maternal prenatal factors and child adiposity with child cardiometabolic risk factors among boys and girls aged 2 years. This was a birth cohort study of 549 term-born children in Shanghai, China, with follow-up data at the age of 2-years. Child anthropometric and adiposity measurements included weight, length, and skinfold thickness (triceps, subscapular, and abdominal). Child cardiometabolic risk factors included random morning plasma glucose, serum insulin, lipids, and systolic and diastolic blood pressure (SBP, DBP). At 2 years, overweight/obesity (weight-for-length z score, ZWFL > 2) was associated with 12.6 (95%CI 7.7, 17.4) mmHg higher SBP, and 7.9 (4.1, 11.8) mmHg higher DBP in boys, with similar results observed in girls. Maternal hypertensive disorders of pregnancy were associated with 3.0 (0.1, 5.8) higher SBP, 3.17 (0.90, 5.44) mmHg higher DBP, 0.24 (0.01,0.47) mmol/L higher plasma glucose, and 0.26 (0.01,0.51) mmol/L higher serum triglycerides after adjustment for child age, sex, and ZWFL. Maternal hypertensive disorders of pregnancy and child overweight/obesity were associated with higher SBP and DBP at the age of 2 years.

Effect of catch-up sleep on obesity in Korean adolescents: a nationwide cross-sectional study

Background

Adolescents have weekday/weekend sleep discrepancies and may compensate for weekday sleep debt through sleep extension on weekends.

Objective

We investigated the effects of total sleep duration on weekdays/weekends on obesity and determined if weekend catch-up sleep has an ameliorating effect on obesity in Korean adolescents.

Methods

Using data from the KNHANES VII, 1,306 middle and high school students were assessed for total sleep duration on weekdays, weekends, and the entire week, as well as weekend sleep extension. Participants were classified into four groups according to weekend sleep extension.

Results

Total sleep duration and weekend sleep duration were negatively associated with body mass index z-score. Increased weekend sleep duration and sleep extension on weekends decreased the relative risk of overweight/obesity with each 30 min increment, reducing the risk by a factor of 0.39 and 0.93, respectively. The risk of overweight/obesity in adolescents who slept less than 6 h on weekdays increased by a factor of 1.93 when they slept for less than 3 h on weekends.

Conclusion

Weekend catch-up sleep had a negative dose-dependent association with obesity in Korean adolescents. Sleeping longer on weekends may be associated with a decreased risk of obesity, even if the adolescent obtains less sleep during weekdays. However, further prospective studies are needed to establish the causality between extended weekend sleep and obesity.